Over the past few years, I've increasingly focused my clinical work on helping people overcome obsessive-compulsive disorder (OCD). It's become a specialism, and one I'm particularly passionate about. But why OCD? Of all the different mental health difficulties I could have chosen to specialise in, why this one? Well, there are quite a few reasons.
1. It's incredibly rewarding
OCD can be an extraordinarily debilitating condition. I've worked with people whose lives have been almost entirely consumed by intrusive thoughts, compulsions and avoidance. It can affect relationships, work, education, social lives and even the most ordinary day-to-day activities. But here's the thing: OCD is also highly treatable. With the right treatment, people can make remarkable progress, sometimes in a relatively short time frame. And there's something enormously rewarding about watching someone gradually reclaim the parts of their life that OCD has taken away. Perhaps they can enjoy spending time with their family again, return to activities they've been avoiding, or simply get through the day without spending hours performing compulsions. The benefits often extend well beyond the individual, making an enormous difference to their partners, families and other people close to them. I sometimes joke that I wouldn't have chosen to specialise in OCD if I didn't believe it was treatable. That would make for a rather demoralising career! Of course, recovery isn't always straightforward, and some people require considerable time and support. But seeing what's possible with effective treatment is a huge part of why I enjoy this work.
2. It's endlessly interesting
One of the things I find most fascinating about OCD is just how diverse it can be. Most people associate OCD with contamination fears, excessive washing, or repeated checking. But OCD can involve almost anything. I've worked with people struggling with intrusive thoughts about relationships, morality, causing harm, sexuality, past events, illness and even the nature of reality itself. And while the underlying mechanisms that maintain OCD are often remarkably similar, the way it manifests can be completely different from one person to the next. Even two people experiencing what we might call the same OCD theme can have very different fears, compulsions and beliefs. Our personalities, experiences, values and circumstances all influence how OCD presents itself. For me, this means the work never becomes repetitive. There's always something new to understand, a different way of looking at a problem or a particular difficulty that requires a slightly different approach. No two people with OCD are the same, and I think that's part of what makes working with them so interesting.
3. It suits my style of therapy
I've always preferred a practical, direct, problem-focused approach to psychological therapy. I enjoy helping people understand what's keeping them stuck, identify what needs to change and then work together to make those changes happen. My style is collaborative, but also quite motivational and action-oriented. In some respects, it probably has more in common with coaching than people's traditional idea of counselling. That's not to say that understanding someone's past isn't important. Our earlier experiences can tell us a great deal about how we've come to see ourselves and the world around us. But I'm particularly interested in what's keeping a problem going now, and what we can do about it. This fits very well with cognitive behavioural therapy (CBT), particularly exposure and response prevention (ERP), which is the main psychological treatment for OCD. ERP is fundamentally about doing things differently. Rather than simply talking about intrusive thoughts and compulsions, we work towards changing how someone responds to them in everyday life. I also prefer therapy to be relatively focused. I'm not someone who believes that people should necessarily spend years in therapy if they don't need to. Of course, some people have more complex or longstanding difficulties that require longer treatment, and that's absolutely fine. But my goal is always to help people develop the understanding, confidence and skills they need to manage their difficulties independently. Ultimately, I want people to become their own therapist, rather than feel they need to keep seeing me indefinitely. There's something particularly satisfying about reaching the point where someone no longer needs your help!
4. I work with some really lovely people
This might sound like an unusual reason to specialise in a particular mental health condition, but it's an important one. I sometimes jokingly refer to OCD as the illness of the kind. Now, I'm not aware of any convincing scientific evidence that people with OCD are inherently kinder than anybody else, so don't take that too literally! But I do find myself working with an enormous number of thoughtful, conscientious, caring and introspective people. Interestingly, some of these qualities can also become entangled with OCD. Someone who cares deeply about other people might become particularly distressed by intrusive thoughts about causing harm. Someone who values honesty and morality might become preoccupied with the possibility that they've done something wrong. Someone who's particularly reflective or conscientious might find themselves repeatedly analysing their thoughts, feelings, and actions. Of course, these qualities aren't necessarily problematic, and having OCD doesn't tell us anything definitive about someone's character. But OCD can sometimes take the things we care about most and turn them into sources of doubt and anxiety. What's particularly sad is that people experiencing these difficulties often have an incredibly negative view of themselves. They might genuinely worry that they're dangerous, immoral, selfish or fundamentally bad. And yet, in my experience, I often work with people who are incredibly thoughtful and considerate of others. It's a privilege to work with them, and I genuinely enjoy getting to know the people behind their OCD.
5. It connects with my medical background
Before becoming a CBT therapist, I trained and worked as a doctor. I worked in several areas of medicine, including general practice and psychiatry, before eventually moving into psychological therapy. One of the areas I've always found particularly interesting is health anxiety. Health anxiety and OCD have a considerable amount in common, particularly when it comes to intrusive worries, reassurance seeking, checking and difficulty tolerating uncertainty. Having a medical background gives me an additional perspective when working with people experiencing fears about their health. I understand physical illness and how medical investigations and treatments work, which helps me appreciate the context of someone's concerns. Of course, treating health anxiety isn't about repeatedly reassuring someone that they don't have a particular illness. In fact, excessive reassurance can keep the problem going. But I find that my experience in medicine complements my psychological work, particularly when trying to understand the relationship between physical health, anxiety and uncertainty. It's a combination of interests that I find especially rewarding.
6. I can relate to some of the experiences
Finally, there's probably a more personal reason. Although I've never really considered myself to have experienced OCD in a clinical sense, I've certainly had my fair share of anxiety over the years. Looking back, particularly during my medical training, I can recognise periods of health-related anxiety and perhaps even some patterns of thinking that weren't entirely dissimilar to OCD. There have also been occasions when I've found myself dwelling on past events or worrying rather excessively about things that, with hindsight, probably didn't warrant quite so much attention. I wouldn't necessarily describe these experiences as OCD, and I certainly wouldn't compare them with the difficulties faced by someone experiencing severe, debilitating symptoms. But I do think they've given me some appreciation of just how convincing anxiety can feel. It's remarkable how easily our minds can become caught up in hypothetical threats, how urgently we can feel the need for certainty, and how difficult it can sometimes be to simply leave a question unanswered. And while clinical training and experience are obviously essential, I think having some personal understanding of anxiety can also help us appreciate what people are going through.
The bottom line
I feel fortunate to have found an area of psychological therapy that I find so interesting, rewarding and well suited to the way I like to work. OCD can be an incredibly difficult condition to live with, but it's also one where effective treatment can make an enormous difference. I enjoy the challenge of understanding how someone's particular OCD operates, helping them recognise the patterns that keep it going and supporting them as they begin to change those patterns. But perhaps the thing I enjoy most is watching people gradually become less dependent on therapy, less restricted by OCD and more able to get on with living their lives. Because in the end, the most rewarding part of my job is helping people reach the point where they no longer need me.